Archives for February 2015

During World War II in 1943 as allied armies were gaining a foothold in Italy, the Southern Italian town of Bari was a major port to supply the growing armies. On December 2nd, 105 German bombers attacked the port catching the allies by complete surprise. 28 allied ships were sunk. One of them, the John Harvey, had a secret cargo of 2000 mustard gas bombs. They were there for retaliation in event of a German chemical warfare attack.

The destruction of the John Harvey released nitrogen mustard into the air and water. 628 service personnel and civilians developed mustard poisoning. 83 ultimately died and many underwent autopsy. At autopsy, changes to the bone marrow and destruction of lymph tissue were noted. This observation led to experiments and the ultimate development of the first chemotherapy, Mustine; and the class of chemotherapy called alkylating agents; many of which are still used today.

Sometimes you have to take drastic steps to regain something you’ve lost.

Sometimes you have to rename the obvious so you can remember it.

Palliative care is a little like that.

In the last decade, patients increasingly make similar complaints about their medical care (wherever they get it):

“Everything’s so fragmented”

“No one has time to communicate”

“My doctor never asked me what I wanted”

“I want to be treated like a person”

“They care more about my illness than me”

“No one will tell me the truth about my cancer”

Yikes.

Taking the long view of medical history, these sorts of complaints are a pretty recent problem. Before antibiotics, before chemotherapy drugs, all we could offer cancer patients was compassion, prognosis, and scrupulous attention to pain relief. It wasn’t much, but it was focused on the suffering human at the center of the illness. And it mattered. Modern medicine has become a victim of its own success.

Paradoxically, as we’ve gotten better at shrinking tumors, we’ve gotten worse at caring for the human soul. Dr. Ira Byock, a palliative care specialist and past president of the AAHPM, has said “it’s not palliative care…just good, competent medical care.” That we need a specialty board to remind us to attend to the human fallout of illness illustrates how negligent we’ve been.

I don’t want to go back to the early 20th century. I want to keep Rituxan, and PET scans, and Gleevec. But I want to take back what we’ve lost. I want to put the human experience back at the center of our duty.